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MONITORING WELL INSTALLATION Ri- -RT <br /> Date:_ ZZZZde25 CONSTRUCTION <br /> Premise Address:_ ����.(/Ld/ - -0 -S Total Depth <br /> Screen Length (from) Co S (to) <br /> Well No.: !�'L ✓ 7 Filter Pack (from) t 0 (to) <br /> p Bentonite (from) t�z' (to) <br /> Inspector: �CGrout (from <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: U <br /> Driller: casing <br /> 6A height <br /> Consultant T <br /> Geologist T <br /> ABOVE-GROUND <br /> COMPLEf{ON C4iRLM-SOX <br /> SPECIAL PERMIT INFO. Ground Surface COMPLETION <br /> Distance to sewer line fiuAk/ grout <br /> Domestic well on site - (y ) �—n <br /> If yes, location and distance - <br /> . ft. <br /> ft. <br /> = m <br /> a <br /> SAMPLING So = o <br /> dotted _ c <br /> °L <br /> !/7 section — � <br /> Holding Tempera <br /> �" <br /> ture <br /> Method 6/10 s W <br /> Pack <br /> Screening Method L414v = <br /> Tracking Sheet - (y 655 <br /> ft. <br /> SPOILS <br /> Storage Method O'M-C. o MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y On <br /> Storage Location Casing type el" <br /> Blank ft. Screen ft. <br /> Slot size 0.QZ-0 <br /> GROUTING Bags cement <br /> c Buckets bentonite <br /> Depth to water ! Bags sand/gravel <br /> Mix Ratios n"41 " Filter Pack type/size <br /> Installation Method Surge Block: - / n ) <br /> Quantity Installed_ <Lc.i Discussed with geologist: - / n ) <br /> Type of method <br /> EH 29 29 <br />